A Rare Pathologic Collecting and Hoarding Behavior Following Left Middle Cerebral Artery Territory Infarction.

BACKGROUND AND SIGNIFICANCE: Punding is the term used to describe complex, purposeless abnormal behaviors that are thought to be related to either excessive dopamine stimulation or inhibition. We report a case of punding after cerebral infarction at the caudate nucleus.

CASE: A 70-year-old man presented with acute-onset motor aphasia. Upon examination, he showed no other neurological deficit. The computed tomography scan and magnetic-resonance imaging scan taken during admission were consistent with acute infarctions of the left caudate nucleus and multiple scattered areas of multiple cortices. Six months after the episode, he gradually became disruptive and ill-tempered. He began to buy and collect assorted repair tools. In addition, he presented hoarding behavior by acquiring unnecessary goods and stacking them at his house.

CONCLUSION

To the best of our knowledge, this is the first case of punding following an ischemic stroke at the caudate nucleus. Our case strengthens the hypothetical pathophysiology of punding, which may involve not only direct dopaminergic stimulation but also the dysregulation of the dopamine system.